Abstract Details

Title Varicella Zoster Vasculopathy Presenting as Eight and a Half Syndrome

Topic Infectious Disease

Presentation(s) P1 - Poster Session 1 (12:00 PM-1:00 PM)

Poster/Presentation
Number 093

Objective NA

Background Varicella-Zoster Virus (VZV) is a DNA virus that belongs to the family of Human Herpesvirus (HHV). After primary infection (Chickenpox) the virus stays latent in the dorsal root or trigeminal ganglia, where it can reactivate as herpes zoster (HZ). HZ may lead to neurologic complications or may affect the vasculature of the central nervous system leading to inflammatory vasculopathy2, one of the more serious complications of VZV. Vasculopathy from VZV may present as transient ischemic attacks, stroke or intracerebral hemorrhage3. HZ has an age-dependent incidence: 1.2-3.4 per 1,000 people/year among younger adults, and 3.9-11.8 per 1,000 people/year in patients over 65 years of age.4 Patients 50 years of age or older have an increased risk of stroke post vasculopathy in the first 3 months post reactivation, but not thereafter5. However, other studies suggest an elevated risk of stroke up to 1 or 2 years later6,7. The diagnosis of VZV reactivation is confirmed by clinical manifestations and radiological findings in accordance with a stroke, and the presence of either VZV DNA or anti-VZV IgG antibodies in CSF3.

Design/Methods

We present a case of a 67 year-old female with past medical history of Rheumatoid Arthritis on immunosuppression, hypothyroidism, hyperlipidemia, and childhood Varicella Zoster infection. Patient arrived at our ER with acute onset of right facial paralysis with lower neuro-pattern and diplopia. On examination the patient had a right eight and a half syndrome8. Presentation was concerning for an infectious process due to fever, tachycardia, and Leukocytosis, on the setting of patient being immunocompromised with methotrexate and prednisone. MRI confirmed a right hemipontine ischemic stroke. Cerebrospinal fluid studies were positive for VZV, confirming diagnosis of ischemic stroke secondary to VZV Vasculopathy. Patient was treated with IV acyclovir and rehabilitation. Secondary stroke prevention was recommended.

Results NA

Conclusions NA

Authors/Disclosures
Silvia Rincon-Rueda, MD PRESENTER	Silvia Rincon-Rueda has nothing to disclose.
Roberto Alejandro Cruz, MD (DHR Health Neurology Institute)	The institution of Dr. Cruz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for AMGEN. The institution of Dr. Cruz has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for ALEXION. The institution of Dr. Cruz has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for AMGEN. The institution of Dr. Cruz has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion.
Daniela I. Salinas	Ms. Salinas has nothing to disclose.

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